| NPI | 1598743320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R WAYNE LUCKETT Certified Prosthetist/ Manager 502-584-2959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2025-05-21 |